Health plans improve on coverage, benefits but lag on costs, member expectations

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Dive Brief:

Americans with commercial health insurance are more satisfied today with their health plans, but payers still lag in meeting financial and personal health expectations of their plan members, a new J.D. Power study finds.

Chief among concerns insurers need to address are higher copays for doctor appointments and care coordination among different providers and settings.

Nearly 29,000 members from 146 health plans in 22 regions nationwide weighed in on their satisfaction on six key areas: billing and payment; cost; coverage and benefits; customer service; information and communication; and provider choice. The regions rated highest for overall member satisfaction are Maryland, California, East South Central, Michigan, Illinois/Indiana and Virginia.

Dive Insight:

Consumers want more information about healthcare costs and alternative options for receiving care. Providers and payers are already moving in that direction with expanded access to and coverage of telehealth. Efforts like Aetna's app for Apple Watch — which reminds users to fill prescriptions, get wellness checkups and immunizations and informs them of lower-cost options for lab tests and imaging — could increase satisfaction, giving people more control over their health and helping to reduce out-of-pocket spend.

The J.D. Power study shows overall health plan member satisfaction up seven points from the prior three years, to 713 on a 1,000-point scale. Fueling the increase is greater satisfaction with coverage and benefits offered.

By contrast, high copays and clunky mobile apps pulled member satisfaction down. "Overall satisfaction scores are 254 points higher when members perceive their plan actively keeps out-of-pocket costs low, helped coordinate care and that there was enough coverage, yet 54% or fewer of health plan members say their plan delivers on each of these criteria," according to the study.

The report also shows people want lower-cost options such as telehealth, urgent care and retail clinics. Nearly half (48%) of respondents said they are very or somewhat likely to consider telehealth, and that share increased to 51% among Gen Y members. Among all members, about a third have used urgent care centers.

In addition to measuring six key factors of consumer satisfaction, the study looked at member experience and engagement. No. 1 in overall satisfaction is Maryland, with a 734 score. California, East South Central and Michigan each received 725, while Illinois/Indiana got 723 and Virginia, 722.

Kaiser Foundation Health Plan came out on top in five regions: California, Colorado, Maryland, Northwest and South Atlantic.

Other winning performers are:

Aetna — Delaware/West Virginia/Washington, D.C., Ohio and Virginia

Cigna — East South Central and New Jersey

AvMed — Florida

Health Alliance Medical Plans — Illinois/Indiana

Health Alliance Plan of Michigan — Michigan

SelectHealth — Mountain

Capital District Physicians Health Plan — New York

"Health plans are doing a good job managing the operational aspects of their businesses, but they are having a harder time addressing the expectations members have based on their experiences in other industries where their service needs are more effectively addressed with better technology," James Beem, managing director of global healthcare intelligence at J.D. Power, said in a statement. "Across the board, health plan members are satisfied with the coverage and benefits they have, but once they start looking to their health plans for guidance in areas like navigating issues related to cost or when to use primary care versus urgent care, many plans miss the mark on customer expectations."

The findings come as states are taking a closer look at payer competition. In April, a federal judge dismissed UPMC's lawsuit against Pennsylvania Attorney General Josh Shapiro, who has pushed to get the integrated health system and insurer to contract with rival Highmark. In reaching the decision, Pennsylvania District Court Judge John E. Jones said UPMC had failed to establish a threat of harm. Also last month, a federal judge in Alabama blocked UPMC's attempt to join a lawsuit challenging the way Blue Cross Blue Shield plans operate.

And last week, the Department of Justice backed health insurer Oscar in its antitrust litigation against Florida Blue Cross Blue Shield and its use of an exclusive broker policy. Oscar has argued the policy hinders competition and hurts people shopping for insurance in Florida's Affordable Care Act market.